Healthcare Provider Details

I. General information

NPI: 1952648727
Provider Name (Legal Business Name): JONATHAN BLAIR ZIFFERBLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2013
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6246 CALLE VERACRUZ
LA JOLLA CA
92037-6918
US

IV. Provider business mailing address

6246 CALLE VERACRUZ
LA JOLLA CA
92037-6918
US

V. Phone/Fax

Practice location:
  • Phone: 858-230-1207
  • Fax:
Mailing address:
  • Phone: 858-230-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA73596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: